Federal Surprise Billing Law in Effect: Get Educated
By Amy Lynn Sorrel

Despite ongoing litigation over certain aspects of the federal surprise billing law, the patient protection components of the No Surprises Act still took effect at the beginning of the year. With them come a number of changes that could significantly impact physician practices now that balance billing is largely prohibited.

That is why Texas Medical Association and American Medical Association leaders are urging physicians to get educated now about the new federal law. Many related practice changes were the subject of an AMA educational webinar held Jan. 20, which is available as a recording.  

With certain federal and state guidance still forthcoming, there remain some outstanding questions about how state surprise billing laws interact with the federal No Surprises Act, Bobby Mukkamala, MD, chair of AMA’s Board of Trustees, told attendees. And other issues about the independent dispute resolution process – informally known as arbitrations –  likely will be resolved through the courts

But given the pressing nature of other requirements in place, New York health lawyer Michael Kolber, of the firm Manatt Health, discussed and advised physicians to acquaint themselves now with four main areas to immediately comply: 

  • How cost-sharing is determined between the physician and the patient, and between the physician and the health plan;
  • What’s needed to provide patients with good-faith estimates, or GFEs, on the cost of services;
  • When physicians can get a patient’s consent to balance bill for nonemergency out-of-network services; and
  • When physicians can get a patient’s consent to balance bill for “post-stabilization” services after an emergency.

As for how some of this is working so far, legal experts praised Texas’ surprise billing law.

“Texas’ law is working pretty well and gets high marks. If you want an example of a pretty robust state enforcement, Texas is a good example of that,” said Joel Ario, also of Manatt Health. He is a former U.S. Department of Health and Human Services official and former National Association of Insurance Commissioners officer. 

Find educational materials, including an AMA Toolkit and TMA’s resource list, on TMA's surprise billing webpage.

Read Texas Medicine Today for updates as TMA develops more detailed materials to help physicians navigate the state and federal surprise billing laws.

Last Updated On

April 05, 2022

Originally Published On

January 21, 2022